True Transosseous Hybrid Rotator Cuff Repair

Abstract

Transosseous repair has been used safely and effectively for primary and revision rotator cuff repair for decades; as a result, it is considered by many the historical gold standard of open repair techniques. Transosseous repair offers the advantage of excellent biology, double-row anatomic footprint reconstruction, and the ability to create multiple lowcost fixation points per surface area of tendon with high-strength suture, while avoiding anchor pullout, cyst formation, and imaging artifact. More recently, in arthroscopic applications, transosseous-equivalent anchor-based repairs have been introduced that have shown satisfactory clinical and biomechanical results; however, these attributes have been coupled with increased cost, nonbiologic burden to the healing interface of the tendon, and new catastrophic failure modes including tendon transection, anchor pullout, and bone voids. This article delineates a technique for arthroscopic true transosseous hybrid cuff repair that combines the use of anchors and transosseous techniques to maximize the benefits and minimize the detriments of both techniques. Level 1 (shoulder); level 2 (rotator cuff).

Clinical and Economic Advantages of Anchorless Arthroscopic Transosseous Suture Repair of the Rotator Cuff

“…1 Since April 2015, we have been using PGA sutures in mattress suturing to achieve initial cuff-securing force and to prevent exerting excessive tension on the rotator cuff. In addition to our method, other approaches for arthroscopic transosseous repair of the rotator cuff without implants include the use of a giant needle, 6,7 ArthroTunneler device (Tornier, Edina, MN, the USA), [8][9][10][11][12][13] hollow needle, [14][15][16] special equipment, [17][18][19][20] and anterior cruciate ligament guide. 21 Moreover, few reports have revealed the clinical outcomes of this technique in more than 50 patients.…”

Comparison of Occurrence of Bone Tunnel Laceration, Clinical Results, and Cuff Repair Integrity of Transosseous Arthroscopic Rotator Cuff Repair With and Without Lateral Cortical Augmentation

“… 11 , 12 To avoid these issues, some surgeons choose transosseous ARCR techniques instead. 13 , 14 , 15 , 16 , 17 , 18 There are various approaches to transosseous ARCR, but these are generally all difficult to perform. However, with the development of a tunneling device, implementing transosseous ARCR has become easier, and we commenced the use of this procedure in our institute in May 2012.…”

The Transosseous Cerclage In Situ Technique for Biceps Tenodesis

“…6 Previous work has shown the reliability of transosseous methods for rotator cuff repair and biceps tenodesis using retrograde passing methods. 6,7 The technique described in this article incorporates some lessons learned from previous techniques of biceps tenodesis.…”

“…In developing transosseous techniques, we have noted the benefit of unlimited fixation points in bone causing load sharing of the construct through increased fixation-point density, as well as the fact that the strength of the construct is determined by the suture number crossing the repair site. 7 The same principle applies to the suture-tendon interface of the biceps to decrease the chance of construct failure. The number of passes around and through the tendon and the length of the tendon engaged are relevant variables that influence pullout strength.…”